Provider Demographics
NPI:1205867652
Name:ROSE, TINA M (NP)
Entity Type:Individual
Prefix:
First Name:TINA
Middle Name:M
Last Name:ROSE
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:550N MAIN ST 3
Mailing Address - Street 2:
Mailing Address - City:ATTLEBORO
Mailing Address - State:MA
Mailing Address - Zip Code:02703-1735
Mailing Address - Country:US
Mailing Address - Phone:508-699-7800
Mailing Address - Fax:508-699-7801
Practice Address - Street 1:550 N MAIN ST
Practice Address - Street 2:SUITE 3
Practice Address - City:ATTLEBORO
Practice Address - State:MA
Practice Address - Zip Code:02703-1735
Practice Address - Country:US
Practice Address - Phone:508-699-7800
Practice Address - Fax:508-699-7801
Is Sole Proprietor?:No
Enumeration Date:2006-07-05
Last Update Date:2016-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA181386363LX0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LX0001XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MANP248303Medicare PIN
MAP08623Medicare UPIN